UMASS MEMORIAL PERFORMS INTESTINAL TRANSPLANT

Procedure previously unavailable in New England

May 12, 2004

WORCESTER, Mass.— A Massachusetts woman has undergone an intestine transplant at UMass Memorial Medical Center, receiving a portion of the organ from her daughter in the first living-related donor transplant in New England.  The seven-hour operation marked the first intestine, or small bowel, transplant at UMass Memorial, newly established as one of just a few centers in the United States able to provide the life-saving procedure.  Previously, patients would have to travel outside New England for surgery and follow-up care.

The patient, 44-year-old Cynthia Dean of Springfield, received a portion of intestine from her 21-year-old daughter, Barbara Dean, on April 29. Both are doing well and have been discharged from the hospital.

Leading the transplant team were Luca Cicalese, MD, Director of the Liver and Intestinal Transplantation Program at UMass Memorial Medical Center and Associate Professor of Surgery and Pediatrics at the University of Massachusetts Medical School; and Giacomo Basadonna, MD, PhD, Director of Organ Transplantation Services and Professor of Surgery.  In addition to Cicalese and Basadonna, Marc E. Uknis, MD, transplant surgeon and Associate Professor of Surgery, and Craig A. Paterson, MD, colon and rectal surgeon and Assistant Professor of Surgery, performed the operation to remove a small section of intestine from the donor.  The procedures also involved considerable expertise and support of medical staff—physicians, nurses, coordinators and others—from numerous departments across the medical center, such as gastroenterology/nutrition, anesthesiology/intensive care, infectious disease, pathology, radiology and social work.

“Because of the breadth of medical expertise and cooperation required among several health care specialties, intestinal transplantation is something few medical centers can offer,” said Dana K. Andersen, MD, Chair of the Department Surgery. “This is has been a true system-wide effort, and UMass Memorial is immensely proud to be able to serve this critical need for Central Massachusetts, New England, and the country.”

The intestinal transplant program highlights UMass Memorial’s concerted efforts to expand its surgical services, particularly in transplantation.  The hospital, which also provides liver, kidney, pancreas/islets, and bone marrow transplantation, won approval from the state to begin providing small bowel and intestine transplantation at the end of January 2004.

The transplantation is a complicated procedure in which a length of functioning intestine is grafted into the abdomen of an individual with irreversible intestinal failure.  Intestinal failure can result from a number of causes, including trauma to the abdomen or “short gut syndrome” in which the organ is too short or is too underdeveloped to allow for proper digestion of food.  It can also be caused by pseudo-obstruction in which, despite adequate length, the organ’s function or motility is abnormal and affects absorption of nutrients and movement of food along the digestive tract.  Other common causes of intestinal failure include volvulus (abnormal twisting of the intestine that causes obstruction), Crohn’s disease, thrombotic disorders (clotting disorders that cause a blood flow problems to the organ) and, in infants, congenital disorders such as necrotizing enterocolitis (an acute intestinal inflammation in premature infants) or intestinal atresia (a congenital abnormality of the intestine).

Many patients with intestinal failure receive nutrients via total parenteral nutrition (intravenous tube feeding or TPN). Long term TPN, however, can be associated with severe and potentially fatal complications such as liver failure and line sepsis, a generalized infection that spreads from the site of the intravenous tube.

“Most patients in need of transplantation tend to be acutely ill and may have already undergone surgery to remove sections of diseased or damaged intestine, and so the procedure is complex and delicate,” said Cicalese, who is a nationally recognized expert in the field and was instrumental in establishing the small bowel transplant program at UMass Memorial.  “The organ itself is also very sensitive to preservation injuries once taken from the donor, so we believe living-donor organ transplants can provide a better option than cadaveric organ transplants. With both the donation and transplant performed in adjoining operating suites, the amount of time the organ is outside the body is greatly reduced.” 

In 2003, 116 intestinal transplants were performed nationwide, the vast majority from cadeveric donors. Living donors are generally able to provide a sufficient length of intestine; their remaining intestine resumes normal function after a short recovery period.  A normal adult has approximately 30 feet of intestine, a highly vascularized organ.  There are currently approximately 191 people on the waiting list for a transplant.  Because there are so few intestinal transplant programs in the country, UMass Memorial expects to serve patients from throughout New England and the northeastern United States.

UMass Memorial Health Care, led by President and CEO John G. O’Brien, is central Massachusetts’ largest not-for-profit health care delivery system, with 1,700 physicians and more than 10,000 employees.  Its comprehensive network of care includes acute care teaching hospitals, affiliated community hospitals, freestanding primary care practices, ambulatory outpatient clinics, long-term care facilities, home health agencies, hospice programs, a rehabilitation group and mental health services. UMass Memorial is the clinical partner of the University of Massachusetts Medical School.

For more information on small bowel transplantation at UMass Memorial, visit www.umassmemorial.org/ummhc/hospitals/med_center/services/transplantation/index.aspx  or phone 508-856-8088.

Contact: Alison Duffy, Public Affairs and Publications, (508) 856-2000